| NPI | 1821225392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301102452) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: UT 7771247-1205) |
| Enumeration Date | 2009-06-11 |
| Last Update Date | 2021-12-20 |